Biliary complications and outcomes of liver transplantation from donors after cardiac death
Biliary complications and outcomes of liver transplantation from donors after cardiac death
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DOI：
10.1002/lt.21212
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发表时间：
2007-12-01
影响因子：
4.6
通讯作者：
Thuluvath, Paul J.
中科院分区：
文献类型：
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作者：
Maheshwari, Anurag;Maley, Warren;Thuluvath, Paul J.
心脏死亡后利用供者的器官进行肝移植(LT)后的胆道并发症尚未得到很好的描述。这项研究的目的是评估心脏死亡肝移植(DCD-LT)后供体后胆道并发症的严重程度和预后。对1997-2006年间的20例DCD-LT进行了回顾性评价。受者年龄53±8.7岁，供者年龄35±11岁。热缺血时间33+/-12min，冷缺血时间8.7+/-2.7h，谷丙转氨酶峰值1757+/-1477U/L，谷草转氨酶峰值40203693U/L。术后出院时胆红素和碱性磷酸酶水平分别为3.2+/-5.4 mg/dL和248+/-200U/L。中位随访7.5个月(范围1-73个月)，5例患者(25%；1例Re-LT后死亡)死亡(3例死于脓毒症，1例死于4个月后复发的肝细胞癌，1例死于46个月时的心脏事件)，4例(20%)患者(1例因肝动脉血栓形成，1例因移植物功能不全，2例因胆道狭窄)，12例(60%)发生胆道并发症，其中11例(55%)有严重胆道并发症。胆道并发症：胆漏2例(10%)，吻合口狭窄5例(25%)，肝门部狭窄7例(35%)，供肝外胆管狭窄9例(45%)，肝内狭窄10例(50%)，结石1例(5%)，管型7例(35%)，碎石2例(10%)。大多数患者出现1个以上的胆道并发症，这些并发症是不可预测的，需要进行多次诊断或治疗。DCD-LT术后严重的胆道并发症是常见的，研究应该集中在确定供体和受体的因素，以预测和预防严重的胆道并发症。
Biliary complications after liver transplantation (LT) using organs retrieved from donors after cardiac death are not well characterized. The aim of this study was to evaluate the severity of biliary complications and outcomes after donation after cardiac death liver transplantation (DCD-LT). A retrospective evaluation of 20 DCD-LTs from 1997-2006 was performed. The recipient age was 53 +/- 8.7, and the donor age was 35 +/- 11 years. The warm ischemia time, cold ischemia time, peak alanine am inotransferase level, and peak aspartate aminotransferase level were 33 +/- 12 minutes, 8.7 +/- 2.7 hours, 1757 +/- 1477 U/L, and 4020 3693 U/L, respectively. The bilirubin and alkaline phosphatase levels at hospital discharge after LT were 3.2 +/- 5.4 mg/dL and 248 +/- 200 U/L, respectively. During a median follow-up of 7.5 months (range: 1-73), 5 patients (25%; 1 death after re-LT) died (3 from sepsis, 1 from recurrent hepatocellular carcinoma at 4 months, and 1 from a cardiac event at 46 months), and additionally, 4 patients (20%) required re-LT (1 because of hepatic artery thrombosis, 1 because of primary graft nonfunction, and 2 because of biliary strictures), Twelve (60%) developed biliary complications, and of these, 11 (55%) had serious biliary complications. The biliary complications were as follows: a major bile leak for 2 patients (10%; both eventually underwent retransplantation), anastomotic strictures for 5 patients (25%), hilar strictures for 7 patients (35%), extrahepatic donor duct strictures for 9 patients (45%), intrahepatic strictures for 10 patients (50%), stones for 1 patients (5%), casts for 7 patients (35%), and debris for 2 patients (10%). More than 1 biliary complication was seen in most patients, and these were unpredictable and required multiple diagnostic or therapeutic procedures. Serious biliary complications are common after DCD-LT, and research should focus on identifying donor and recipient factors that predict and prevent serious biliary complications.